Anthony Razzak, MD, of The Oregon Clinic GI East in Portland, outlines how he is approaching colorectal cancer screening during the pandemic.
Question: How has your practice approached the screening backlog?
Dr. Anthony Razzak: This was and remains a daunting task. In the Pre-COVID era, we had a system in place that triaged patients referred for screening procedures and were able to identify those with symptoms or high-risk features (i.e. family history) that would allow for more accurate risk stratification. With the initial COVID restrictions, we ceased all elective cases and focused our efforts on those with urgent and semi-urgent indications. We transitioned consultative care from in-person visits to telephone and virtual care and compiled a wait list. As restrictions lessened, we resumed endoscopic services on a limited but growing basis, prioritizing patient, staff and provider protection. This required taking inventory of PPE and understanding our ASC air circulation. We have encouraged pre-procedure COVID testing and attempted to increase our scheduling flexibility by offering Saturday procedures. This continues to require effort on all fronts.
Q: How has your practice performed screenings safely and what's something others can learn from your success?
RA: We implemented full PPE precautions (N-95 fit testing and PPE competencies for all staff), terminal cleaning and full air exchanges for all procedures. We screen every employee daily and screen every patient for symptoms at the seven-day pre-procedure call, and prior to the procedure. We implemented frequent cleaning throughout the day for high-touch areas. We monitor our surface cleaning regularly with 'Glow-test' and provide feedback to housekeeping.
We limited visitors to our waiting room and requested that all patient rides wait in the car while we escort the patient back to the car after the procedures.
Q: If the second-wave of COVID-19 cases causes your practice to delay screenings, what would it mean to you and how would these delays impact CRC risk?
RA: A second wave of COVID will likely result in reduced services and contribute to delay in those seeking elective care. While a delay in timing to screening colonoscopy may impact overall CRC risk, I also feel we have to acknowledge the lingering effects from COVID restrictions and the potential fear in seeking medical care. In the pre-COVID era there remained a significant portion of patients not seeking colon cancer screening and I fear this pandemic could make willing patients more hesitant.
All available data demonstrates the health beneficial impact of colonoscopy on colorectal cancer prevention; however, if patients are too afraid to undergo testing all benefit is lost. We continue to actively reassure patients and advertise the safety measures that have been implemented in hopes that patients feel comfortable seeking care with our practice. I foresee this being an ongoing obstacle and hope it does not reverse the current down trending colorectal cancer incidence in those aged 50-plus. We need to continue aggressive efforts and educating those outside the traditional screening guidelines (i.e. those less than age 50) to be aware of their digestive health and not hesitate to seek care when needed.